Method and system for determining a relative position of a tool

ABSTRACT

Presented are methods and systems for determining, monitoring, and displaying the relative positioning of two rigid bodies such as during a surgery. In particular, the present disclosure relates to methods and systems for positioning a prosthesis relative to a bone during a surgery as well as to systems and methods for verifying resulting relative positioning of adjacent bones.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. application Ser. No.17/558,151, filed Dec. 21, 2021, (the “'151 application”), the entirecontents of which is incorporated herein by reference. The '151application is a continuation of U.S. application Ser. No. 16/180,517,filed Nov. 5, 2018, (the “'517 application”), the entire contents ofwhich is incorporated herein by reference. The '517 application is acontinuation of U.S. application Ser. No. 14/799,909 (patented), filedJul. 15, 2015, (the “'909 application”). The '909 application is acontinuation of U.S. application Ser. No. 13/328,997 (patented), filedDec. 16, 2011 (the “'997 Application”). The '997 application claims thebenefit under 35 U.S.C. § 119(e) of U.S. Provisional Patent ApplicationNo. 61/424,447, filed Dec. 17, 2010, the entire disclosure of which isherein incorporated by reference in its entirety.

TECHNICAL FIELD

The present disclosure relates generally to determining, monitoring anddisplaying the relative positioning of two rigid bodies during surgery.In particular, the present disclosure relates to methods and systems forpositioning a prosthesis relative to a bone during a surgery as well asto systems and methods for verifying resulting relative positioning ofadjacent bones.

BACKGROUND

Joint replacement surgery involves replacing an existing joint withartificial prosthetic components. Examples of common joint replacementsinclude hip replacements and knee replacements. Hip replacement may besegmented into three types: primary, revision and resurfacing. Primaryhip replacement, also called Total Hip Arthroplasty (THA), involves thesurgical excision of the head and proximal neck of the femur and removalof the acetabular cartilage and subchondral bone. Commonly, anartificial canal is created in the proximal medullary region of thefemur, and a metal femoral prosthesis is inserted into the femoralmedullary canal. An acetabular component or implant is then insertedproximally in the enlarged acetabular space.

Hip resurfacing, like THA, involves the surgical removal of theacetabular cartilage and subchondral bone, and the subsequent insertionof an acetabular prosthetic. Unlike THA, resurfacing does not involvethe excision of the femoral head, but rather covering the existingfemoral head with a prosthetic cap, which mates with the acetabularprosthetic. Hip resurfacing is often done with younger patients topreserve femoral bone stock for future revisions.

Revision hip surgery is typically performed when an artificial hip jointfails, due to factors such as infection, loosening, fracture, mechanicalfailure or instability. Revision hip surgery typically involves thereplacement of one or more of the failed artificial prosthetics,depending on the reasons for failure.

Nearly 1,000,000 hips are replaced in North America and Europe everyyear. Approximately 75% of these procedures are primary, with 15%revision and 10% resurfacing. Studies indicate that the number of hipreplacements will increase over the coming years due to many factors.

An important aspect of hip replacement is ensuring proper alignment ofthe acetabular component or implant with respect to the pelvis.Specifically, studies have shown that failure to properly align theacetabular component or implant with the pelvis may lead to prematurewear, propensity to dislocate and patient discomfort.

Another important aspect of hip replacement is ensuring the change inleg length and offset resulting from the procedure is acceptable.Typically, the goal is to leave the leg length and offset unchanged as aresult of the procedure. However, surgeons will often incorporate asmall change in leg length as a corrective measure.

BRIEF DESCRIPTION OF THE DRAWINGS

For a better understanding of embodiments of the systems, methods anddevices described herein, and to show more clearly how they may becarried into effect, reference will be made, by way of example, to theaccompanying drawings in which:

FIG. 1 is a front view of a healthy hip joint;

FIG. 2 is a front view of a hip joint after THA;

FIG. 3A is a front view of a pelvis illustrating the angle of abduction;

FIGS. 3B and 3C are front views of a pelvis illustrating the angle ofanteversion;

FIGS. 4A and 4B are comparative diagrams of a hip joint, illustratingthe measures of leg length and offset before and after the hipreplacement procedure, respectively;

FIG. 5 is a block diagram of a system for a surgical navigation systemfor hip replacement in accordance with at least one embodiment;

FIG. 6 is a side view of a patient's hip having a pin or bone screwinserted in the pelvis through skin or other soft tissue;

FIG. 7A is one embodiment of a sensor unit;

FIG. 7B is another embodiment of a sensor unit;

FIG. 7C is another embodiment of a sensor unit;

FIG. 7D is another embodiment of a sensor unit;

FIG. 7E is another embodiment of a sensor unit;

FIG. 7F is an embodiment of a marker array;

FIG. 8 is a side view of a patient's hip with a sensor unit coupled tothe pelvis via a pin or bone screw in the pelvis;

FIG. 9A is an isometric view of a stylus;

FIG. 9B is an isometric view of the stylus of FIG. 9A having a sensorunit coupled thereto;

FIG. 10 is an isometric view of the acetabular implant insertion toolwith a stylus and sensor unit attached;

FIG. 11 is a pelvis registration device in contact with a pelvis havinga sensor unit on one arm of the device, according to an embodiment;

FIG. 12 is a side view of the patient's pelvis having a sensor unitattached thereto along with a stylus having a sensor unit contacting alandmark on the pelvis;

FIG. 13 is a side view of a patient's pelvis with a sensor unit attachedthereto, and a femur having a sensor unit attached thereto via a bonescrew or pin;

FIG. 14 is a side view of a patient's pelvis having a sensor unitattached thereto, and an acetabular reaming tool having a sensor unitattached thereto, located near the patient's acetabulum;

FIG. 15 is a side view of a patient's pelvis having a sensor unitattached thereto, and an acetabular implant insertion tool having asensor unit attached thereto;

FIG. 16 is a side view of a patient's pelvis having a sensor unitattached thereto, and a patient's femur having a sensor unit attachedthereto via a bone screw or pin after the prosthetic femoral componentshave been installed and artificial joint assembled;

FIG. 17 is a side view of a patient's pelvis with one embodiment of asensor unit coupled to the pelvis via the pin or bone screw in thepelvis;

FIG. 18A is an isometric view of another stylus;

FIG. 18B is an isometric view of the stylus of FIG. 18A having a markerarray coupled thereto;

FIG. 19 is an isometric view of an acetabular implant insertion toolwith a marker array attached thereto;

FIG. 20 is another pelvis registration device having a marker array onone arm of the device, shown in contact with a pelvis;

FIG. 21 is a side view of a patient's pelvis having a sensor unitattached thereto, and a stylus, having a marker array connected thereto,contacting a landmark on the pelvis;

FIG. 22 is a side view of a patient's pelvis with one embodiment of thesensor unit attached thereto, and a patient's femur having a markerarray attached thereto via bone screw or pin;

FIG. 23 is a side view of a patient's pelvis having one embodiment of asensor unit attached thereto, and an acetabular reaming tool having amarker array attached thereto;

FIG. 24 is a side view of a patient's pelvis having one embodiment of asensor unit attached thereto, and an acetabular implant insertion toolhaving a marker array attached thereto;

FIG. 25 is a side view of a patient's pelvis having one embodiment of asensor unit attached thereto, and a patient's femur having a markerarray attached thereto via bone screw or pin after the prostheticfemoral components have been installed;

FIG. 26 is a flow chart of a method for performing THA according to oneembodiment;

FIG. 27 is a flow chart of a method for using the system including asurgical navigation tool, in hip replacement procedures in accordancewith an embodiment;

FIG. 28A is a flow chart of a method for determining a relative positionof a first sensor unit with respect to a pre-determined geometry of abone in accordance with one embodiment;

FIG. 28B is a flow chart of a method for determining a relative positionof a first sensor unit with respect to a pre-determined geometry of abone in accordance with another embodiment; and,

FIG. 29 is a flow chart of a method for determining the relativepositioning of a bone and a rigid body in accordance with oneembodiment.

FIG. 30 is a schematic drawing of a computer system used to implementthe systems and methods presented

It will be appreciated that for simplicity and clarity of illustration,elements shown in the figures have not necessarily been drawn to scale.For example, the dimensions of some of the elements may be exaggeratedrelative to other elements for clarity. Further, where consideredappropriate, similar reference numerals may be used among the figures toindicate corresponding or analogous elements (e.g. reference sensor 811of FIG. 8 is analogous to reference sensor 1211 of FIG. 12 ).

DETAILED DESCRIPTION

It will be appreciated that numerous specific details are set forth inorder to provide a thorough understanding of the exemplary embodimentsdescribed herein. However, it will be understood by those of ordinaryskill in the art that the embodiments described herein may be practicedwithout these specific details. In other instances, well-known methods,procedures and components have not been described in detail so as not toobscure the embodiments described herein. Furthermore, this descriptionis not to be considered as limiting the scope of the embodimentsdescribed herein in any way, but rather as merely describing theimplementation of the various embodiments described herein.

The described embodiments relate to methods and systems for aligning,positioning and sizing prostheses during surgery. The exemplary methodsand systems relate to determining the positional relationship of bodyparts with prostheses, body parts with other body parts, body parts withtools and prostheses with tools. The term “positional relationship”refers to a rigid-body transformation between coordinate systems (e.g. ahomogenous transformation). In Cartesian space (i.e, 3D space), therigid-body transformation consists of 6 Degrees-of-Freedom (DOF): 3-DOFfor translational position and 3-DOF for rotational position, ororientation. In this document, the terms “positional relationship” or“relative position” encompass 1 to 6 DOF. The number of DOF of apositional relationship may be explicitly stated (e.g., 2-DOF), orimplied by the context (e.g., 3-DOF are needed to describe orientationin general). In some instances, positional relationship is determined byfirst determining the 6-DOF positioning, then extracting the desiredpositional information described by less than 6-DOF. More generally,“positional relationship” implies determining the positioning betweentwo rigid bodies and their corresponding coordinate systems, neither ofthe rigid bodies being considered “fixed” to a global coordinate system.

In one embodiment, a first (or reference) sensor unit is attached to abody part, for example, the pelvis. The relative position of the bodypart (i.e., pelvis) with the first sensor unit must be determined. Thisis commonly referred to as “registration” to those skilled in the art.There are known methods to perform pelvis registration. One registrationmethod involves using intra-operative imaging. Another method ofregistration involves measuring the positioning of the sensor unit withat least three landmarks (or reference locations) on the body part. Asurgical tool having a second sensor unit may contact three landmarks(or reference locations) simultaneously or successively. The combinationof the first sensor unit attached to the body part, and the secondsensor unit on the surgical tool, may permit the relative positioning ofthe first sensor unit on the body part with respect to the at leastthree landmarks or reference locations (and therefore the body partitself), to be determined. In one embodiment, the registrationdetermines only the 3-DOF relative rotational position (i.e.,orientation) of the first sensor unit with the pelvis.

In another embodiment, the orientation of a prosthesis with respect to abody part is determined using sensor units. Such sensor units mayinclude without limitation emitters or markers, and/or sensors. Onesensor unit may be attached to the body part, with another sensor unitattached to the surgical tool. The combination of the sensors/markersmay allow the relative three-dimensional orientation of the surgicaltool (with the prosthesis attached) and the body part to be measured.

In another embodiment, the relative positioning of two body parts aredetermined using two sensor units. For example, in hip replacementsurgery, one may wish to determine the relative positioning of thepelvis with respect to the femur, or point on the femur. This may beaccomplished by attaching a first (or reference) sensor unit to one bodypart (i.e., the pelvis), and another sensor unit to the other body part(i.e., the femur), such that the combination of sensor units are able tomeasure the relative positioning between the two body parts.

For ease of explanation, the methods and systems will be described withreference to aligning an acetabular and femoral implant during THA.However, it will be evident to a person of skill in the art that themethods and systems described herein may be applied to other types ofhip replacement, i.e., hip resurfacing, revision hip replacement, aswell as to other surgical procedures where a prosthesis is implanted,such as, for example, knee replacement surgery.

I. Description of Total Hip Replacement

Before proceeding to a detailed description of the embodiments ofmethods and systems for aligning a prosthetic component or implant, abrief description of total hip replacement (THR) or THA will be providedwith reference to FIGS. 1-4 .

Reference is first made to FIG. 1 , in which a healthy human hip joint100 is illustrated. As can be seen from FIG. 1 , the hip joint 100includes a socket 102, referred to as the acetabulum, in the pelvic bone104, which is lined with acetabular cartilage 106. In a healthyindividual, the femoral head 108 at the upper end of the femur 110 isreceived in the acetabulum 102.

Reference is now made to FIG. 2 , in which a human hip joint 200 afterTHR or THA surgery is illustrated. During THR or THA, the acetabulum 202is reamed out (i.e. acetabular cartilage 106 of FIG. 1 is removed), andan acetabular component or implant 220 is attached to the acetabulum202. The femoral head (e.g. femoral head 108 of FIG. 1 ) of the femur210 is also removed. Specifically, the femur 210 is opened out accordingto known methods, and a ball and stem component 211, referred to as thefemoral component, is inserted into the opened-out femur 210.

An important aspect of THA is ensuring proper alignment of theacetabular component or implant with respect to the pelvis.Specifically, studies have shown that failure to properly align theacetabular component or implant with the pelvis may lead to prematurewear, propensity to dislocate and patient discomfort.

The orientation of an acetabular component or implant 220 with respectto the pelvis anatomy is defined by angles of abduction and anteversion.Reference is now made to FIGS. 3A, 3B, and 3C, which all depict a frontview of a pelvis with an acetabular implant 320 to illustrate angles ofabduction and anteversion. In FIG. 3A, the direction of abduction isindicated by arrow 330, and the angle of abduction is indicated by angle332. Generally speaking, abduction relates to the sideways pivoting ofthe acetabular component or implant 320 within the acetabulum 302.

Referring now to FIGS. 3A-3C, the direction of anteversion is indicatedby arrow 333. FIG. 3B shows the acetabular implant 320 with zero degreesof anteversion. Rotation of the acetabular implant 320 about the axis340 such that the socket of the implant is visible to the readerconstitutes a positive angle of anteversion. For example, the acetabularimplant 320 of FIG. 3C has a positive angle of anteversion. Generallyspeaking, anteversion relates to the tilting of the acetabular componentor implant 320 within the acetabulum 302 in a vertical direction (i.e. avertical direction with respect to a patient lying face up on anoperating table). Abduction and anteversion may be defined operatively,radiographicly, and anatomically.

Studies have shown that for a typical healthy patient, the range ofabduction is ideally between 30 and 50 degrees, and the range ofanteversion is ideally between 5 and 25 degrees.

Also highly desirable to the successful outcome of a hip replacement isachieving a desired resulting leg length, offset and center of rotationof the femur. The definition of leg length and offset with respect tothe anatomy of a body is documented in the literature and is known tothose skilled in the art. With reference to FIGS. 4A and 4B, a hip andfemur before replacement 400 a (FIG. 4A) and after replacement 400 b(FIG. 4B) are shown from an anterior-posterior view. The original leglength 405 a and offset 407 a are components of the vector between alandmark (or reference location) on the pelvis 401 and a landmark on thefemur 403. The resulting leg length 405 b and offset 407 b arecomponents of the vector between the same landmarks: on the pelvis 401and the femur 403. The resulting leg length 405 b and offset 407 b aredetermined by the location of the center of rotation (COR) of the femur408 b, as well as the dimensions of the femoral implant. The originalleg length 405 a and offset 407 a may be measured using a pre-operativescan (e.g. x-ray, CT scan, and MRI), as well as the original femoral COR408 a. A desired change in leg length and offset may be calculated basedon a desired resulting leg length and offset and the original leg length405 a and offset 407 a.

It may be important that the resulting leg length 405 b and offset 407 bmatch the pre-operatively determined desired values, with respect to theoriginal leg length 405 a and offset 407 a, in order to help ensure asuccessful surgery and desired mobility and durability of the prostheticjoint. A desired resulting leg length and offset may be achieved bymonitoring the leg length and offset during surgery (using sensor units)and effecting the desired change in leg length and offset. It may alsobe desirable to determine the pre and post operative femoral CORposition, including the Anterior-Posterior change of the femoral CORposition. This may be accomplished using sensor units.

II. System Level Description of Apparatus

Reference is now made to FIG. 5 , in which a system 500 for measuringthe relative positioning of body parts with body parts, body parts withprostheses, body parts with tools and tools with prostheses inaccordance with an embodiment of the present invention is illustrated.The exemplary system 500 includes a plurality of sensor units 502, 503,504, 505, and 506, that cooperate to measure relative positioningbetween the components to which they are connected (wherein theconnections shown in FIG. 5 denote wired or wireless transmissions). Afirst sensor unit (or reference sensor unit) 502 is operativelyconnected to the pelvis of a patient 507, for example by fixing a pin orbone screw into the patent's pelvis and by screwing, clipping orotherwise mounting the first (or reference sensor unit) 502 to the pinor bone screw, as will be discussed further below. A second sensor unit503 is operatively connected to a sensor positioning device 508.Additional sensor units 504, 505, and 506 are operatively connected to afemur of the patient 507, an acetabular prosthesis insertion tool 509,and a reaming device 530, respectively. As will be described in furtherdetail below, each of sensors 503, 504, 505, and 506 may be substitutedfor a marker or marker array.

Acetabular prosthesis insertion tool 509 and reaming device 530 aremerely examples of surgical tools (or rigid bodies) that may form partof the system 500, and are commonly used during hip replacement surgery.The ordinary skilled person will appreciate that different surgicaltools used to attach other medical prostheses to corresponding bodyparts or bones of the patient are also contemplated herein. The system500 may also include a computing device 511 which may comprise aprocessor 512, a display device 514, and a database 516.

The display device 514 may display information related to the surgicalprocedure. Typically the displayed information is intended for thesurgeon, for example, the orthopaedic surgeon during hip replacement.The display device 514 may be a computer monitor, television, LCDtouchscreen, seven segment display, tablet, smart phone or any othertype of display. The display device 514 may be a stand-alone unit,currently integrated in the operating room, or may be attached to asurgical tool, e.g., 509, 530. The information being displayed mayinclude, but is not limited to, relative positioning information of bodyparts, tools, or prostheses. In one embodiment, the display device 514shows the angles of abduction and anteversion of the acetabularcomponent. In another embodiment, the display device 514 shows reamingdepth and angle information. In another embodiment, the display device514 shows the change in leg length and offset. Other relevantinformation to the surgery may also be displayed. For example, medicalimaging, where available, may be displayed, along with a representation(e.g. an augmented reality representation) tracking the real timemovement the various surgical tools and bones involved in the surgicalprocedure.

In the exemplary embodiment, the computing device 511 interfaces with atleast one of the sensor units 502, 503, 504, 505, 506 and the displaydevice 514. The computing device 511 receives sensor data, and processesit to determine relative positioning information. In one embodiment, theprocessing includes using the Extended Kalman Filter (EKF), or avariation of it (i.e., the Iterative EKF). In another embodiment, theprocessor 512 includes a nonlinear iterative solver such as theLevenberg-Marquardt method. The sensor data that computing device 511receives contains enough information to determine the desired relativepositioning data (in other words, the desired relative positioning datais preferably at least locally observable given the sensor information—the term “locally observable” being used as it is commonly understood inthe art of control and estimation). The computing device 511 formats thedata and, in some embodiments, may relay the formatted data to adatabase 516 for storage. Additional information relevant to thesurgical procedure, but not necessary for determining relativepositioning (e.g. date, time, and personal information about thepatient), may also be sent to a database 516 for storage. The database516 may be located in the operating room, in the hospital, in a centralmedical information repository, or any other location where storing datasecurely is possible.

The computing device 511 may also send processed data to a display 514,and may comprise other user input devices, such as a keyboard or mouse(not shown), which may be used to interact with information displayed on514. Furthermore, the computing device 511 may interface with medicalimaging data (e.g. x-rays, CT scans, MRI), and may in turn display thisdata to the display 514.

A. Hip prosthetic alignment system and method.

Many orthopaedic surgeons fasten a pin or bone screw to the pelvisduring hip replacement. With reference to FIG. 6 , an example of a pinor bone screw 610 rigidly fastened to the ilium 601 of the pelvis 604 ofa patient 607 (represented by a dashed line) is shown. In this instance,the pin or bone screw 610 has been inserted through skin and other softtissue of the patient 607 and fixed to the patient's ilium 601 byscrewing or impacting, though operatively connecting 610 may be done onother locations on the pelvis (e.g., in the surgical wound). As will befurther described below, the pin or bone screw 610 may be used as aninterface to mount a sensor unit. For example, pin or bone screw 610 maybe used to mount a first (or reference or pelvis) sensor unit (e.g.sensor unit 502 of FIG. 5 ) to the pelvis 604 of the patient 607. Asimilar pin or bone screw may also be used to mount a separate (orsecond) sensor unit (e.g. sensor 504 of FIG. 5 ) to a femur (not shown)of the patient 607. A sensor unit may be mounted to a pin or bone screw,for example, by screwing the sensor onto a threaded end of the pin orbone screw extending from patient's pelvis, or by clipping, or otherwisefastening the sensor unit onto the end of the bone screw or pin. It willbe apparent to those skilled in the art that other means of operativelyconnecting a sensor unit to a bone may be used (e.g., a bio-compatibleadhesive).

With reference to FIGS. 7A to 7D, four different sensor units 701, 711,721, 731 are described. FIGS. 7A, 7B, and 7D provide examples of sensorunits (701, 711, and 731, respectively) having at least one opticalsensor embedded (704, 714, and 734, respectively).

An optical sensor refers to any sensor capable of receiving light, anddetermining the direction of the light source. A typical optical sensormay be a CMOS, CCD, or other type of camera. Another example of anoptical sensor is a photo-sensitive device (PSD). Another example of anoptical sensor is a product called Shadow Sense, offered by Baanto Inc.(Mississauga, ON). Other examples of optical sensors will be apparent tothose skilled in the art. In one embodiment, the optical sensor receivesinfra-red (IR) light; however, optical sensors are not to be limitedherein to sensing light in the IR spectrum.

FIGS. 7A to 7C provide examples of sensor units 701, 711, and 721,respectively, having markers (705, 715, and 725, respectively). In oneembodiment (particularly, where IR optical sensors are used), themarkers are IR markers. An ordinarily skilled person will appreciatethat a marker is not required to be of the IR variety, but rather maycomprise any object which appears as an identifiable feature on an imagetaken by a corresponding optical sensor. Other examples of markersinclude, but are not limited to, retro-reflective markers (whichpreferably accompany a light-energy source directed towards the marker),and light emitting diodes (LED). Markers 705, 715, and 725 have beenillustrated as point light sources. It will be apparent to those skilledin the art that non-point light sources may be used, and may havebenefits over point light sources.

With reference to the sensor unit 701 of FIG. 7A, sensor unit 701 may becoupled to a rigid body (e.g. a bone or surgical tool) via mountingbracket 702. For example, sensor unit 701 may be coupled to a bone screwor pin (e.g. 610 of FIG. 6 ) via mounting bracket 702. Sensor unit 701is enclosed by housing 703. Sensor unit 701 contains at least oneoptical sensor 704, not obstructed by the housing 703. Sensor unit 701contains two markers 705. Sensor unit 701 may also contain additionalsensors 706 within the housing. The additional sensors 706 may includebut are not limited to accelerometers, gyroscopes, and magnetometers.

A processor 707 may be embedded within the sensor unit 701. The embeddedprocessor 707 may convert analog data to digital data, and may filter orotherwise condition data and prepare said data for transmission via thecommunication channel 709. Communication channel 709 may be wired, orwireless, and may communicate over any suitable protocol (e.g. RS-232,BlueTooth®, WiFi, USB, SPI, I2C, IR). Sensor unit 701 is powered by apower source 708, which may include but is not limited to an internalbattery, or an external power cable. In embodiments where a battery isused as the power source 708, the sensor unit 701 may also be equippedwith recharge terminals (not shown).

A sensor unit in general may have a plurality of markers. For example,FIG. 7B illustrates an exemplary sensor unit 811, which has four markers715. Sensor unit 711 is otherwise similar to sensor unit 701. When morethan 3 markers are placed on a sensor unit, it may be advantageous forthe markers to be positioned such that they do not lie in the same plane(e.g., sensing may be more robust).

FIG. 7C illustrates a sensor unit 721 having four markers 725, but nooptical sensor. Sensor unit 721 is otherwise similar to sensor units 701and 711. As mentioned, it may be advantageous that, where greater than 3markers are used, the markers are not all co-planar.

FIG. 7D illustrates a sensor unit 731 having an optical sensor but nomarkers. Sensor unit 731 is otherwise similar to sensor units 701, 711,and 721.

In general, to measure 6-DOF relative positioning between 2 sensorunits, at least one optical sensor and at least three markers arerequired between the two sensor units. It is preferable to have morethan the minimum combination of optical sensors and markers. To measurerelative positioning in less than 6-DOF, fewer markers may be required.

Reference is now made to FIG. 8 , in which the pelvis 804 of a patient807 (shown as a dashed line) is illustrated. A pin or bone screw 810 isattached to the patient's pelvis 804 and sensor unit 811 is mountedthereto and functions as a first (or reference or pelvis) sensor unit.Sensor unit 711 (FIG. 7 ) has been selected as the first (or referenceor pelvis) sensor unit 811 for exemplary purposes.

The purpose of the first (or reference or pelvis) sensor unit 811 is toprovide sensor measurements (in a pelvis frame of reference) to acomputing device (e.g. 511 of FIG. 5 ), to ultimately determine relativepositioning information between other components of the system (e.g. thepelvis bone, the femur, surgical tools, and prosthetics). The pelvisframe of reference is related to sensor unit 811 by a method such asregistration. In one embodiment, registration is performed by locating aplurality of landmarks or reference locations (e.g. the anteriorsuperior iliac spine (ASIS) 803, the anterior inferior iliac spine(AIIS) 817, and points along the iliac crest 806) on the patient'spelvis with respect to the first (or reference or pelvis) sensor 811.

With reference to FIGS. 9A and 9B, a stylus 901 that may be used (alongwith a sensor), in one embodiment, to locate landmarks (or referencelocations) on the patient's pelvis with respect to the first (orreference or pelvis) sensor unit (e.g. 811 of FIG. 8 ) is described.Stylus 901 comprises a rigid body having a proximal end 902 and a distalend 903. The distal end 903 has a well-defined contact point to be usedto contact body parts and/or other features or landmarks (or referencelocations), and the proximal end 902 is adapted to receive a sensor unit905. Sensor unit 905 may be one of sensor units 701, 711, 721, or 731,illustrated in FIG. 7 and may additionally be equipped with at least onehuman interface sensor, such as button 906. The button 906 may beinterfaced with a processor (not shown) internal to the sensor unit 905.In one embodiment, the stylus 901 is used to determine the positioningof landmarks or reference locations (e.g. 803, 817, and 806 of FIG. 8 )on the pelvis with respect to the first (or reference or pelvis) sensorunit 811 (FIG. 8 ). Depression of the button 906 may signal to thecomputing device (e.g. 511 of FIG. 5 ) and/or first (or reference orpelvis) sensor (e.g. 811 of FIG. 8 ) that the stylus is in contact witha landmark or reference location, and accordingly that the sensor unit905 is in a pre-determined location with respect to the landmark orreference location. Depression of the button 906 may also cause therelative positioning of the sensor unit 905 to be registered/saved.

With reference to FIG. 10 , an acetabular cup insertion tool 1000 havinga sensor unit 1005 attached thereto, according to one embodiment, isdescribed. The sensor unit 1005 is secured to the tool 1000. In oneembodiment, the sensor unit 1005 is the same sensor as sensor 905 (FIG.9 ). In one embodiment the sensor unit 1005 is the same sensor as sensor905, also attached to stylus 901 (FIG. 9 ), and the stylus 901 isdirectly attached to the acetabular cup insertion tool 1000—in thisembodiment, the stylus 901 may be secured to the tool 1000 by securing afree end 903 of the stylus 901 within a coupler 1013, for example usinga set screw (not shown). In alternative embodiments, the coupler 1013,which may be integrally formed with the tool 1000, may be provided withthreads for mating with complementary threads on one end of a couple(e.g. a pin) 1001, and the other end of the coupler (e.g. a pin) 1001may be provided with threads for mating with complementary threadsprovided to sensor unit 1005. Alternatively to using threads, amechanical clip, for example, may also be used to couple the sensor unit1005 to the coupler 1001 and the coupler 1001 to coupler 1013 of thetool 1000. The sensor unit 1005 may comprise any one of the sensor units701, 711, 721, and 731 described with reference to FIG. 7 . Furthermore,sensor 1005 may be coupled to the insertion tool 1000 via a coupler1001, which, in one embodiment, may be the stylus 901. The end of theinsertion tool 1000 holds the acetabular prosthetic implant (oracetabular cup) 1015. The sensor unit 1005 is connected to the tool 1000in a known or measurable orientation such that the relative position ofthe sensor unit 1005 with respect to the insertion tool 1000 is knownwhen the two elements are connected. For example, where an insertiontool, coupler, and sensor are manufactured to known dimensionalspecifications, and such that the three components may only be assembledin one particular fashion, the three components may be assembled in apredictable manner according to calculated relative positioning. Wherethe dimensions of one or more of the components used are adjustable(e.g. the pelvis registration device described directly below), therelative position of the components may be determined by measuringdistances and angular orientations between the components.

In another embodiment described with reference to FIG. 11 , a pelvisregistration device 1100 may be used to contact three landmarks (orreference locations) on the pelvis. In one embodiment, the first andsecond contact members 1117, 1106 are used to contact the respectiveASIS points 1103 at first and second contact points 1107, 1109,respectively, on the contact members 1117, 1106, and a third contactmember 1110 to contact a palpable location on the iliac crest 1105 at athird contact point 1111 on third contact member 1110. Other pelviclandmarks (reference locations) may be used, and would be apparent tothose ordinarily skilled in the art (e.g. the Anterior Inferior IliacSpine, the pubic tubercles, the acetabular rim, the attachment point ofthe ligamentum teres, etc.). An example device is disclosed in PCTpublication number WO/2010/063117, which is incorporated by referenceherein in its entirety. The first and second contact members 1117, 1106are attached to first and second adjustable stand-offs 1114, 1116, whichare themselves secured to a cross-member 1124. The rigid member (orshaft) 1102 is free to rotate about the axis of its length, oralternatively may be clamped such that it may not rotate, and extendsbeyond stand-off 1114 (the portion of the rigid member or shaftextending beyond stand-off 1114 being indicated as 1122). The thirdcontact member 1110 is attached to a third stand-off 1108, which iscoupled to the extended portion 1114 of the rigid member (or shaft) 1102via joint 1118. The third stand-off 1108 is preferably operativelycoupled to the rigid member (or shaft) 1102 such that the rotation ofthe rigid member (or shaft) 1102 about the axis of its length causes asimilar rotation of the third stand-off 1108 about said axis. By way ofnon-limiting example, the third stand-off may be integrally formed orwelded with the rigid member (or shaft) 1102 (or portion 1122 of therigid member or shaft extending beyond stand-off 1114).

The third contact member 1110 is suitably shaped to contact a palpablepoint along the iliac crest 1105. A coupler 1131 is connected to thethird stand-off 1108 and a second sensor unit 1130 is connected to thecoupler 1131. By way of non-limiting example, the coupler 1131 may be apin with two threaded ends adapted to mate with complementary threads inthe third stand-off 1108 and the second sensor 1105. It will beappreciated by those skilled in the art that, although it is preferablethat the coupler 1131 be connected to the third stand-off 1114, thecoupler may alternatively be connected to a separate component of theregistration device 1100, provided that the separate component of theregistration device to which the coupler 1131 (and the second sensor1130 when coupled to the coupler 1131) is coupled is operativelyconnected to the third stand-off 1108 (i.e. a rotation of the thirdstand-off 1108 about an axis of rotation will cause a similar rotationof the separate component about the same axis of rotation). It is alsopreferable that the relative position of the second sensor unit 1130with respect to the first, second, and third contact points 1107, 1109,1111, is known when the second sensor unit 1130 is coupled to acomponent of the pelvis registration device 1100 via the coupler 1131(i.e. the second sensor unit 1130, when coupled to the pelvisregistration device 1100, has a pre-determined relationship to each ofthe first, second, and third contact points 1107, 1109, 1111).

As such, all of the mechanical dimensions of the pelvis registrationdevice 1100 are either fixed and known, or adjustable and measurable.Furthermore, at least one human interface sensor (e.g. button 1132),which may be located anywhere on the pelvis registration device 1100,may be interfaced to the sensor unit 1130 for the purpose ofcommunicating to the computing device (e.g. 511 of FIG. 5 ) that thedevice 1100 is in position with respect to the patient's pelvis. In oneembodiment, the button 1132 comprises three pressure sensors at each ofthe first, second, and third contact points 1107, 1109, 1111, such thata particular pressure at each point will indicate to the computingdevice (e.g. 511 of FIG. 5 ) that the pelvis registration device 1100,is in the desired position with respect to the pelvis.

The pelvis registration device 1100 may be used to determine thepositioning of landmarks or reference locations (e.g. 803, 817, and 806of FIG. 8 ) on the pelvis with respect to the first (or reference orpelvis) sensor unit 811 instead of the stylus embodiment described withreference to FIGS. 9A and 9B. Similarly to second sensor unit 905 ofFIG. 9 , second sensor 1130 may be one of sensor units 701, 711, 721, or731, illustrated in FIG. 7 .

With reference to FIG. 12 , a method for determining the relativepositioning of a first (or reference or pelvis) sensor unit 1211 withrespect to the pelvis 1204 of a patient 1207 (shown in dashed lines)using the stylus/sensor unit combination of FIG. 9 , is described. Withthe first (or reference or pelvis) sensor unit 1211 operativelyconnected to the pelvis 1204 of the patient 1207 (for example, asdescribed above), the stylus 1201 is brought into contact with a pubictubercle 1208 (a bony landmark on the pelvis 1204) using the distal end1202 of the stylus 1201 (as illustrated in FIG. 12 ). When the stylus1201 is appropriately engaged with a bony landmark (either directly onthe bone, or through skin and other soft tissue), button 1212 may bedepressed to indicate that the stylus 1201 is engaged, which initiates acommunication transmission from second sensor unit 1205 to either acomputing device (e.g. 511 of FIG. 5 ) or the first (or reference orpelvis) sensor unit 1211. In one embodiment, first (or reference orpelvis) sensor unit 1211 and second sensor unit 1205 will be selectedand positioned such that one of the sensors comprises at least onecamera and the other sensor comprises corresponding markers that liewithin the at least one camera's field of view at the time ofcommunication transmission. At the time of communication transmission,the aggregate information available to sensor units 1211 and 1205 issufficient to determine the relative 6-DOF positioning between thesensor units 1211 and 1205. Therefore the 6-DOF positioning of the first(or reference or pelvis) sensor 1211 relative to the bony landmark incontact with the stylus 1201 at the time of communication transmission,may be determined.

In one embodiment, it may be desirable to register the femur (often foruse in determining leg length/offset). In such an embodiment, it ispossible to contact landmarks along the femur using stylus 1201.

Those skilled in the art will appreciate that certain combinations ofsensor units 1211 and 1205 will be deficient for the purpose ofproviding sufficient information to determine relative positioning. Forexample, if sensor unit 721 of FIG. 7 (comprising only markers, and nocamera) is used as sensor unit 1211, then sensor unit 721 may not beused as sensor unit 1205, and vice versa. If sensor 731 (comprising acamera and no markers) is used as either of sensor units 1211 or 1205,then the remaining sensor unit is preferably of type 711 or 721 (i.e.one which preferably comprises at least three markers). There are manycombinations of sensor unit types which will not provide sufficientaggregate information to determine relative positioning, which will alsoinclude sensors with no corresponding measurements (i.e., a camera onone sensor, with no markers on the corresponding sensor). It will beclear to those skilled in the art which sensor unit combinations areappropriate (i.e. the desired relative positioning is locallyobservable).

In order to determine the relative positioning of the first (orreference or pelvis) sensor unit 1211 with respect to the patient'spelvis 1204, the positioning of at least three separate known landmarks(or reference locations) on the pelvis are identified and stored in thecomputing device (e.g. 511 of FIG. 5 ). Some examples of possible bonylandmarks (or reference locations) include the pubic tubercles 1208, theASIS points 1203, the AIIS points 1217, points along the iliac crest1206 or bony landmarks (or reference locations) associated with theacetabulum 1216, such as the attachment point of the ligamentum teres.

Reference is now made to FIGS. 11 and 12 . As previously discussed, inanother embodiment, the pelvis registration device 1100 of FIG. 11 maybe used to determine the relative positioning of a first (or referenceor pelvis) sensor unit 1211 with respect to the pelvis 1204 of a patient1207 (shown in dashed lines in FIG. 12 ). With the first (or referenceor pelvis) sensor unit 1211 operatively connected to the pelvis 1204 ofthe patient 1207 (for example, as described above), the pelvisregistration device 1100 is brought into contact with at least threeknown landmarks (or reference locations) on the pelvis. By virtue of thesecond sensor unit 1130 having a pre-determined relationship ormeasurable to each of the first, second, and third contact points 1107,1109, and 1111, the relative positioning of the first (or reference orpelvis) sensor unit 1211 with respect to the second sensor 1130 may beused to determine the relative positioning of the pelvis bone 1204 withrespect to the first (or reference or pelvis) sensor unit 1211, when thepelvis registration device 1100 is in contact with the at least threelandmarks (or reference locations).

As previously discussed with reference to FIGS. 4A and 4B, in hipreplacement, obtaining a desired change in leg length and offset beforeand after surgery may be highly desirable. Reference is now made to FIG.13 to illustrate how a desired leg length and offset (e.g. 405 b and 407b) may be effected through a hip surgery. A patient's pelvis 1304 andfemur 1306 are illustrated, where the head of the femur 1301 and theregion of the acetabulum 1302 are exposed within the surgical wound. Inorder to measure the positioning of the femur 1306 with respect to thepelvis 1304, a femur sensor unit 1305 is coupled to the femur 1306 (forexample, but not limited to, using a pin having two threaded ends, oneend for screwing into the femur, and the other end for mating withcomplementary threads on the femur sensor unit 1305, or alternatively bydriving a pin into the femur and mechanically clipping the sensor ontothe pin). In one embodiment, the sensor unit 1305 is coupled to thefemur 1306 using a pin or bone screw 1310 b proximate the greatertrochanter 1309. In another embodiment, the sensor unit 1305 positionedso that it lies along either the mechanical or anatomical femoral axis(e.g., it may be percutaneously coupled near the distal femur).

There are several methods of measuring the changes in pre and postoperative leg length and offset. In the art of hip navigation, somemethods rely on determining the location of the center of rotation ofthe femoral head (referred to as head center). Such methods includearticulating the femur or registering the femoral head and/or theacetabulum. Some methods rely on resolving a distance measurement intocomponents representative of leg length and offset. Such methods includeperforming a femoral registration to determining the mechanical and/oranatomical femoral axis.

The information measured by the femur sensor unit 1305 and the first (orreference or pelvis) sensor unit 1311 is transmitted to a computingdevice (e.g. 511 of FIG. 5 ), and contains enough information todetermine the relative positioning of the sensor units, and thereforethe relative positioning of the femur 1306 with the pelvis 1304. Thisinformation, possibly in conjunction with information regarding thefemur head center and/or the femoral axis, may be measured both beforeand after the surgery. A comparison of the information measured afterthe surgery and the information measured before the surgery (i.e., hipreduction with prosthetic components) may yield the actual changes inleg length and offset as a result of the surgery. Similarly, theanterior-posterior change in femur position may be determined. It may besaid that the desired resulting leg length and offset has been effectedif the actual changes in leg length and offset match the pre-determineddesired changes in leg length and offset. The sensor unit options forthe femur sensor unit 1305 are the same options previously discussed asavailable for selection as the stylus sensor unit 905 (of FIG. 9 ).

With reference to FIG. 14 , prior to inserting the acetabular implant(e.g. 1015 of FIG. 10 ), the acetabulum 1402 is reamed, which entailsthe removal of bone, cartilage and other tissue. Reaming of theacetabulum may be performed, for example, using a reaming tool 1401. Areaming sensor unit 1405 may be coupled to the reaming tool 1401, suchthat the combination of the first (or reference of pelvis) sensor unit1411 and the reaming sensor 1405 measure enough information to determinethe relative positioning of the reaming tool 1401 with respect to thepelvis 1404 (this requires, for a given first (or reference or pelvis)sensor 1411, that the reaming sensor unit 1405 be selected in the sameway as the femur sensor 1305). One exemplary purpose of measuring therelative positioning of the reaming tool 1401 with respect to the pelvisbone 1401 is to determine the depth, angle, etc. of the reamingprocedure. The reaming sensor unit 1405 may be coupled using a pinhaving two threaded ends, one for mating with complementary threads onthe reaming tool 1401, and another for mating with complementary threadson the reaming sensor unit 1405. Alternatively, a pin may be integrallyformed with the reaming sensor unit 1405 or a marker array (see, e.g.,reaming tool 2301 of FIG. 23 ) and may have threads complementary tothreads in the reaming tool 1401. Another alternative includes forming apin integral with the reaming tool, having threads complementary tothreads in the reaming sensor unit 1405. A mechanical clip may also beused in the place of threads.

Another important factor in hip replacement is the alignment of theacetabular implant (e.g. 1015 of FIG. 10 ) with respect to the pelvis(particularly with reference to the angles of abduction (e.g. 332 ofFIG. 3A) and anteversion (e.g. 333 of FIG. 3C)). With reference to FIG.15 , once the acetabulum 1502 has been appropriately reamed, theacetabular implant 1515 is inserted into the acetabulum 1502 usinginsertion tool 1510, and impacted into the acetabulum 1502 using asurgical hammer (not shown). Until insertion into the acetabulum 1502,the acetabular implant 1515 is coupled to the insertion tool 1510 in aknown position (i.e. knowing the position of the tool 1510 impliesknowing the position of the acetabular implant 1515). Similarly to theinsertion tool 1000 of FIG. 10 , a tool sensor unit 1505 is coupled tothe insertion tool 1510 in a known position. Using information fromsensor units 1511 and 1505 communicating with a computing device (e.g.511 of FIG. 5 ), the relative positioning of the acetabular implant 1515with respect to the pelvis 1504 may be determined. Particularly, therelative orientation of the acetabular implant 1515 with respect to thepelvis 1504 (i.e. the angles of abduction and anteversion) may bedetermined. Once the surgeon achieves the desired orientation of theacetabular implant 1515 with respect to the pelvis, the surgeon maysecure the implant 1515 within the acetabulum 1502.

Measurement of a change in leg length and offset using a plurality ofsensors was previously discussed with reference to FIG. 13 . Toreiterate, it may be important to measure any changes in leg length oroffset during the procedure intra-operatively. FIG. 16 illustrates how adesired resulting leg length and offset may be effected using aplurality of sensor units. After the implantation of the acetabularprosthetic 1615 and the femoral prosthetic 1608 (see also 208 of FIG. 2), the artificial joint is assembled, or reduced (typically first withtrial components to allow for changes in sizing). The resultingpositioning includes actual resulting leg length (e.g. 405 b of FIG. 4B)and actual resulting offset (e.g. 407 b of FIG. 4B). The change betweeninitial reference measurement of the positioning of a point on the femurwith respect to the pelvis and the positioning of the same point afterthe artificial joint has been assembled may be calculated. This meansthat the change in leg length and offset may be determined from theaggregate information from sensors 1611 (in the pelvis 1604) and 1605(in the femur), recorded both before and after the surgery. In order toaccurately determine leg length and offset, it may be advantageous toalso calculate the femoral head center location, or to use a femoralpositioning procedure (which may include determination of head centerlocation) to facilitate the comparison between initial andpost-reduction measurements (e.g., to guide the surgeon in restoring theinitial femur orientation).

B. Stereoscopic One Active Sensor Unit Embodiment.

In the previous section, an apparatus for measuring relative positioningof tools with body parts, body parts with other body parts, and bodyparts with prosthetics was disclosed, in the context of, among otherthings, aligning and sizing prosthetic components for hip replacementsurgery. In this section, one embodiment of this apparatus with similarfunctionality is disclosed.

In this embodiment, only one sensor unit contains optical sensors. Withreference to FIG. 7E, a sensor unit 741 is shown, having a housing 743and two optical sensors 742 a, 742 b, a known distance apart,unobstructed by the housing 743. The sensor unit 741 may contain othertypes of sensors (not shown) within the housing 743, such asaccelerometers or gyroscopes. Furthermore, the sensor unit 741 mayinclude a human interface sensor (e.g. a button) 746 (multiple humaninterface sensors are contemplated), interfaced to its internalprocessor. This sensor unit 741 may be mounted to, for example, apelvis, via mounting bracket 744 adapted to mate with a complementarymounting bracket on the surgical tool (for example by way of a snap fit,or via mating threads). Reference is now made to FIG. 7F, in which threedifferent marker configurations 751 a, 751 b, 751 c are shown. Eachconfiguration is a sensor unit which has a rigid body 752 a, 752 b, 752c connecting the markers 753 a, 753 b, 753 c, respectively. The markersmay emit or reflect electro-magnetic energy (e.g. visible light, IRlight). In one embodiment, the type of energy that the markers emit orreflect corresponds to the type of sensor unit 741 being used. Sensorunits comprising markers, but no processing or sensing capability arealternatively referred to as “arrays”. Any number of markers 753 maymake up a single “array” 751, depending on the positioningdegrees-of-freedom that the application is required to determine (e.g.to determine all 6-DOF, at least three markers are needed per array).

With reference to FIG. 17 , a sensor unit 1711 attached to a pin or bonescrew 1710, which is attached to the pelvis bone 1704 of a patient 1707,is discussed. In practice, the sensor unit is preferably connected tothe bone such that the field of view of the sensor unit 1711 encompassesthe general area of the surgical wound.

FIG. 18A illustrates a stylus 1801 similar to stylus 901 of FIG. 9A.FIG. 18B illustrates the stylus of FIG. 18A with a marker array 1805coupled thereto. Array 1805 comprises three markers (but may comprisemore) as 6-DOF positioning will be required in the exemplary embodiment.

FIG. 19 illustrates an acetabular cup insertion tool 1900 similar toacetabular cup insertion tool 1000 of FIG. 10 . Insertion tool 1900comprises a marker array 1905 coupled to it via a coupler 1913, forexample, using similar coupling techniques as described above. The array1905 preferably includes at least two marker points (only 2 points areneeded where the proper positioning of the acetabular cup (or implant)depends only on two orientation angles: abduction 332 (FIG. 3A) andanteversion 333 (FIG. 3C)).

In FIG. 20 , an embodiment of a pelvis registration device 2000 isillustrated. This device is identical to the pelvis registration device1100 of FIG. 11 , with the exception that a marker array 2030,preferably comprising at least three markers, is used instead of sensorunit 1130. In one embodiment, device 2000 is used for the same purposeas device 1100 (FIG. 11 ). It may be preferable, where device 2000 isused, to have a human interface sensor (e.g. a button) on the first (orreference or pelvis) sensor unit (e.g. 1711 of FIG. 17 ) instead of onthe device 2000 so that device 2000 may be free of a communicationchannel.

In FIG. 21 , a system is illustrated such that the location of bonylandmarks (or reference locations) on the pelvis may be determined withrespect to a first (or reference or pelvis) sensor unit 2111. The stylus2101 and array 2105 may be used to contact various landmarks (orreference locations) on the pelvis (e.g. the ASIS points 2103 and theAIIS points 2117). When in contact with a bony landmark (or referencelocation), a button (not shown) on the sensor unit 2111 may be pushed inorder to indicate that the stylus 2101 is in contact with a landmark (orreference location). In one embodiment, at least three landmarks (orreference locations) are contacted with their locations determined bymeasuring the array 2105 positioning using the sensor unit 2111. Inanother embodiment, landmarks along the femur are recorded where afemoral registration is necessary.

In an alternative embodiment, a pelvis registration device 2000 of FIG.20 may be used to determine the bony landmarks (or reference locations)on a pelvis with respect to a first (or reference or pelvis) sensor unit2111 by simultaneously contacting at least three landmarks (or referencelocations).

As previously discussed, measuring the change from pre-operative leglength (e.g. 405 a of FIG. 4A) and offset (e.g. 407 a of FIG. 4A) to leglength (e.g. 405 b of FIG. 4B) and offset (e.g. 407 b of FIG. 4B) afterprosthetics have been implanted may be important. With reference to FIG.22 , in the present embodiment, a reference pre-operative leg length(e.g. 405 a) and offset (e.g. 407 a), may be measured by operativelyconnecting an array 2205 to the femur 2206 using the pin or bone screw2210 b (as described above). The first (or reference or pelvis) sensorunit 2211 may be used to determine the pre-operative referencepositioning of the femur 2206 with respect to the pelvis 2204 bytracking the markers on array 2205.

Reaming of the acetabulum according to the present embodiment is nowdiscussed with reference to FIG. 23 . Reaming is performed during thepreparation of the acetabulum for prosthetic implantation. An exemplarytool 2301 is shown, and coupled to it is an exemplary array 2305,preferably with at least three markers, such that the first (orreference or pelvis) sensor unit 2311 is able to measure the positioningof the reaming tool by way of localizing each marker of the array 2305.The array 2305 may be coupled to the tool 2301, for example, accordingthe coupling options as described above.

Another important consideration during hip surgery that has beendiscussed herein is the orientation of the acetabular implant componentwith respect to the pelvis. With reference to FIG. 24 , an exemplarysystem used to determine the relative orientation of an acetabularimplant 2415 with respect to the first (or reference or pelvis) sensor2411 is discussed. The first (or reference or pelvis) sensor unit 2411is able to track the array 2405 optically, and measure sufficientinformation to determine the relative position of the array 2405. Thearray 2405 is coupled to the insertion tool 2410 in a known (orpre-determined) relative position (for example, as described above), andthe insertion tool 2410 is coupled to the acetabular implant 2415 in aknown relative position. The acetabular cup may be coupled to thecorresponding surgical insertion tool, for example, via mating threads.Consequently, the first (or reference or pelvis) sensor unit 2411, whichis coupled (for example, as described above) to the pelvis in a knownrelationship to a pre-determined geometry of the pelvis 2404 (e.g.measured from a pre-operative scan of the pelvis), enables the computingdevice (not shown in FIG. 24 ) to determine the position of theacetabular implant 2415 relative to the pelvis' geometry.

Reference is now made to FIG. 25 , which illustrates how the presentembodiment may be used to measure leg length (e.g. 405 b of FIG. 4B) andoffset (e.g. 407 b of FIG. 4B) after the artificial joint has beenassembled (typically done with trial components to determine the propersizing before implanting the permanent components). The first (orreference or pelvis) sensor unit 2511 may be used to measure therelative positioning of the marker array 2505 (marker array 2505 willtypically be the same as marker array 2205 of FIG. 22 ). A comparison ofthe relative positioning of marker array 2505 (after surgery) with therelative positioning of marker array 2205 (before the surgery) may beperformed in order to calculate the change in leg length and offset oncethe artificial joint (combination of 2508 and 2515) has been assembled.

III. Method of Use

Reference is now made to FIG. 26 , in which an example method for a hipreplacement procedure is presented, in schematic form, and to FIGS. 1and 2 , in order to provide context for the methods and systemsdescribed herein. At block 2602, the patient is prepared for surgery(i.e. cleaning, sedating, positioning, etc.). The surgical procedurestarts with an incision, at block 2604, which ultimately exposes the hipjoint 100 (after getting through several different layers of tissue). Atblock 2606, the patient's hip joint is dislocated, such that the femoralhead 108 no longer resides in the acetabulum 102. In total hipreplacement, the head of the femur 108 is removed (or resected) as block2608 suggests (the femoral head 108 may be resected before dislocatingthe joint at block 2606). Typically, the next aspect of the surgicalprocedure involves reaming of the acetabulum 102 (block 2610) in orderprepare the acetabulum 102 for insertion of the acetabulum implant 220.Once the acetabulum is reamed, the prosthetic acetabular implant 220 maybe implanted as per block 2612. The femur also requires reaming (block2614) so that the femoral prosthetic component 211 (comprising a femoralball and stem) may be received into the femur 210. Femoral reaming maybe performed using a femoral broach. Once reaming of the femur 210 iscomplete, a trial femoral prosthetic may be implanted into the femur, asper block 2616. At block 2618, trial neck and ball components are usedto assemble the trial femoral implant. At block 2620, the artificialjoint (combination of 208 and 211) is assembled, and the patient's jointrange of motion is may be tested. If the trial components do not fitwell, then new trial neck and ball (of different sized) may be attachedand tested until a desired fit is achieved. Once the desired fit isachieved, then actual prosthetics for implantation (as opposed to trialones) are sized accordingly at block 2622. At block 2624, the trialfemoral components are replaced by the actual prosthetics and areimplanted. At block 2626, the artificial joint is assembled, and the fitof the joint is once again verified. Finally, at block 2628, thesurgical wound is closed.

Reference is now made to FIG. 27 , which illustrates a method 2700outlining how the disclosed systems may be used in the context of a hipreplacement surgery. The method 2700 of FIG. 27 is typically performedcontemporaneously with the method 2600 of FIG. 26 ; accordingly,continuing reference is made to FIG. 26 . At block 2702, which may beperformed at any time prior to block 2710, but will typically be done inpreparation for surgery, a pre-determined geometry of the pelvis of thepatient undergoing the operation is input into the computing device.Since every patient's pelvis geometry is unique, this step is performedso that pelvic landmark locations (or reference locations) arecorrelated to the actual pelvis geometry by a computing device (e.g. 511of FIG. 5 ). If the patient's pelvis geometry obtained via any suitablemedical imaging procedure is unavailable, a default pelvis template maybe used. Once the patient has been prepped (e.g. block 2602), the first(or reference or pelvis) sensor unit (e.g. 1211 of FIG. 12 ) isoperatively connected to the pelvis (e.g. 1204 of FIG. 12 ), which maybe achieved, for example, by connecting the first (or reference orpelvis) sensor (e.g. 1211) to a pin or bone screw (e.g. 1210) rigidlyattached to the pelvis (e.g. 1204) at blocks 2704 and 2706.

At block 2708, which occurs subsequent to block 2602 (patient prepping)and prior to block 2606 (hip joint dislocation), and involves contactingat least three pelvic landmarks (or reference locations) using either astylus and second sensor unit combination (e.g. 1201 and 1205 of FIG. 12or 2101 and 2105 of FIG. 21 ) or a pelvis registration device (e.g. 1100or 2000), and measuring the position of the landmarks (or referencelocations) with respect to the first (or reference or pelvis) sensorunit (e.g. 1211). At block 2710, the locations of the landmarks (orreference locations) are correlated by a computing device (e.g. 511 ofFIG. 5 ) with the preoperative imaging data or the default templategeometry of step 2702, so that the relative positioning of the pelvissensor unit (e.g. 1211) with respect to the pelvis (e.g. 1204) may bedetermined.

At blocks 2712 and 2714, a sensor unit or marker array (e.g. 1605 ofFIG. 16 or 2205 of FIG. 22 ) is operatively connected to the patient'sfemur (e.g. 1606), for example, as described above. The operativeconnection may be done via a pin or bone screw (e.g. 1610 b) fastened tothe femur (e.g. 1606). At block 2716, the first (or reference or pelvis)sensor unit (e.g. 1611 of FIG. 16 or 2211 of FIG. 22 ) and possibly thefemur sensor unit or marker array (e.g. 1605 or 2205) communicate withthe computing device (e.g. 511 of FIG. 5 ) such that an originalrelative femur positioning is determined and stored while the joint isstill intact. At this point in the hip replacement procedure, block 2606(hip dislocation) may be performed.

At block 2718, which is typically performed contemporaneously with block2610 of the hip replacement procedure (acetabular reaming), the first(or reference or pelvis) sensor unit (e.g. 1611 or 2211) and possiblythe reamer sensor unit or marker array (e.g. 1405 of FIG. 14 or 2305 ofFIG. 23 ) communicate with the computing device (e.g. 511 of FIG. 5 )such that through their respective measurements, the relativepositioning of the reaming tool (e.g. 1401 of FIG. 14 and 2301 of FIG.23 ) and pelvis during reaming is determined and displayed to thesurgeon, for example via a display (e.g. 514 of FIG. 5 ). Thispositioning data may be formatted to indicate a reaming angle and areaming depth. Furthermore, this data may be saved to a database (e.g.516 of FIG. 5 ).

At block 2720, which is performed in conjunction with block 2612 of thehip replacement procedure (implantation of acetabular implant), thefirst (or reference or pelvis) sensor unit (e.g. 1511 and 2411) andpossibly the insertion tool sensor unit or marker array (e.g. 1505 ofFIG. 15 or 2405 of FIG. 24 ) communicate with the computing device (e.g.511 of FIG. 5 ) such that through their respective measurement, therelative positioning of the acetabular implant (e.g. 1515 of FIG. 15 and2215 of FIG. 22 ) and pelvis (e.g. 1504 and 2404) during alignment isdetermined and displayed to the surgeon, for example, via a display(e.g. 514 of FIG. 5 ). This positioning data may be formatted toindicate angles of abduction and anteversion (e.g. 332 and 333 of FIGS.3A and 3C, respectively). Furthermore, this data may be saved to adatabase (e.g. 516 of FIG. 5 ). Once the positioning is to the surgeon'ssatisfaction, the acetabular implant (e.g. 1515 of FIG. 15 and 2215 ofFIG. 22 ) may be implanted (block 2612).

Blocks 2614, 2616, 2618, and 2620 may be specific to total hipreplacement. Those skilled in the art will appreciate that correspondingsteps in other types of hip replacement procedures or other types oforthopaedic surgeries, generally, may be appropriate depending on thenature of the surgery being performed.

At block 2722, when checking the fit of the joint with trial prosthetics(blocks 2618 and 2620), the first (or reference or pelvis) sensor unit(e.g. 1611 of FIG. 16 and 2511 of FIG. 25 ) and possibly the femursensor unit or marker array (e.g. 1605 or 2505) communicate with thecomputing device (e.g. 511 of FIG. 5 ) such that the change in trialfemur positioning is determined based on the stored reference femurposition and the new measurements. This information may be displayed tothe surgeon, for example, via a display (e.g. 514 of FIG. 5 ),preferably in the form of change in leg length (i.e. 405 b minus 405 a)and change in offset (i.e. 407 b minus 407 a). The surgeon may use thisinformation to size the femoral prosthetics (step 2622). Furthermore,this information may be stored in a database (e.g. 516 of FIG. 5 ).

Once the femoral prosthetics for implantation are selected, they areimplanted, as per block 2624, and the artificial joint is assembled, asper block 2626. At this point, it is possible to verify the positioningof the femur with respect to the joint, as suggested at block 2724. Thefirst (or reference or pelvis) sensor unit (e.g. 1611 of FIG. 16 and2511 of FIG. 25 ) and possibly the femur sensor unit or marker array(e.g. 1605 or 2505) communicate with the computing device (e.g. 511 ofFIG. 5 ) such that the change in actual femur positioning may bedetermined based on the stored reference femur position and/or the trialfemur measurement and the new measurements. This information isdisplayed to the surgeon, for example, via a display (e.g. 514 of FIG. 5), preferably in the form of change in leg length (i.e. 405 b minus 405a) and change in offset (i.e. 407 b minus 407 a). The surgeon may usethis information to verify that the resulting joint alignment issatisfactory. Furthermore, this information may be stored in a database(e.g. 516 of FIG. 5 ). At this point, the surgical wound may be closed(block 2628).

With reference to FIGS. 28A and 28B, method 2800 a, 2800 b fordetermining a relative position of a first sensor unit with respect to apre-determined geometry of a bone is described. Reference will also bemade to FIGS. 11 and 12 . According to this exemplary embodiment, thebone is a patient's pelvis (e.g. 1104 and 1204). The method of FIG. 28Ais applicable where, for example, a stylus (e.g. 1201) having a secondsensor unit (e.g. 1205) is used to gather positioning information ofbony landmarks (or reference locations) on the bone.

Specific reference is now made to FIGS. 28A and 12 . At block 2802 a, apre-determined geometry of the bone (e.g. pelvis 1204) is input into acomputing device (e.g. 511 of FIG. 5 ). The geometry may bepre-determined by taking measurements based on a pre-operative scan(e.g. x-ray, CT scan, and MRI) of the patient and may be input using aninput device, such as a keyboard or mouse, in communication with thecomputing device (e.g. 511 of FIG. 5 ). Where a pre-operative scan ofthe patient (or other suitable data from which the geometry of the bonemay be pre-determined or measured) is unavailable, a default bonetemplate (e.g. pelvis template) may be used.

At block 2804 a, a first (or reference) sensor unit 1211 is operativelyconnected to the bone 1204, for example, as described above. Thisconnection may be achieved, for example, by fixing a pin or bone screw1210 to the bone 1204 and attaching the reference sensor unit 1211 tothe pin or bone screw 1210 in a known orientation.

At block 2806, a second sensor unit 1205 is positioned in a first sensorunit location having a pre-determined relationship to a first referencepoint. In the embodiment illustrated in FIG. 12 , a stylus 1201 havingthe second sensor unit 1205 attached thereto in a known position is usedto contact a pubic tubercle 1208 (a first reference location). Whilemaintaining contact between the end of the stylus 1201 and the firstreference location (and therefore maintaining the second sensor unit1205 in a first sensor location), first information relating to therelative positioning of the second sensor unit (and therefore the firstreference location) with respect to the reference sensor unit 1211 iscommunicated to the computing device (e.g. 511 of FIG. 5 ), as per block2808. The information may be communicated by either the second sensorunit 1205 or the reference sensor unit 1211. Other example referencelocations include, but are not limited to, ASIS points 1203, AIIS points1217, and points along the iliac crest 1206, or the point of attachmentof the ligamentum teres.

At blocks 2810 and 2812, and 2814 and 2816, respectively, similar stepsare performed to the steps at blocks 2806 and 2808, except now for thesecond and third reference locations. For example, a stylus 1201 havingthe second sensor unit 1205 attached thereto may be used to contactsecond and third reference locations, respectively. When the stylus isin contact with the second reference location, the second sensor unit isin a second sensor location having a second pre-determined relationshipto the second reference location. Similarly, when the stylus is incontact with the third reference location, the second sensor unit is ina third sensor location having a third pre-determined relationship tothe third reference location.

When the second sensor unit is in the second and third sensor location,respectively, second and third information, respectively, relating tothe relative positioning of the second sensor unit (and therefore to thesecond and third reference locations, respectively) with respect to thereference sensor 1211 is communicated to the computing device (e.g. 511of FIG. 5 ). Once again, the second and third information may becommunicated by either the second sensor unit 1205 or the referencesensor unit 1211. Further examples of second and third referencelocations include, but are not limited to, ASIS points 1203, AIIS points1217, and points along the iliac crest 1206. It may be desirable to usemore than three reference locations to improve registration accuracy.One constraint on the selection of the reference locations is that theybe separate non-collinear reference locations and that they be landmarksidentifiable for the purpose of pre-determining the geometry of thebone.

At block 2818 a, the computing device (e.g. 511 of FIG. 5 ) correlatesthe first second and third information and the first, second, and thirdpre-determined relationships with the pre-determined geometry storedwithin the computing device. The correlation allows the relativeposition of the bone with respect to other rigid bodies (possessing therequired sensors and markers, apparent to those skilled in the art) tobe determined and monitored using the first sensor unit 1211 and thesecond sensor unit on the rigid body.

Specific reference is now made to FIGS. 28B and 11 . Method 2800 b ispreferably performed for the same purpose as method 2800 a—to determinea relative position of a bone with respect to a reference sensor unitoperatively connected to the bone. However, method 2800 b differs frommethod 2800 a in that a registration device (e.g. pelvis registrationdevice 1100 and 2000) is used to position the second sensor unit in aknown relationship to at least a first, second, and third referencelocation simultaneously.

At block 2802 b, a pre-determined geometry of the bone (e.g. pelvis1204) is input into a computing device (e.g. 511 of FIG. 5 ). Thegeometry may be measured based on a pre-operative scan of the patientand may be input using an input device, such as a keyboard or mouse, incommunication with the computing device (e.g. 511 of FIG. 5 ). Where apre-operative scan of the patient (or other suitable data from which thegeometry of the bone may be measured) is unavailable, a default bonetemplate (e.g. pelvis template) may be used.

At block 2804 b, a reference sensor unit (e.g. 1211 of FIG. 12 ) isoperatively connected to the bone 1104, for example, as described above.This connection may be achieved, for example, by fixing a pin or bonescrew (e.g. 1210 of FIG. 12 ) to the bone 1104 and attaching thereference sensor unit (e.g. 1211 of FIG. 12 ) to the pin or bone screw(e.g. 1210 of FIG. 12 ) in a known orientation.

At block 2805, a second sensor unit is positioned in a sensor unitlocation. When in the sensor unit location, the second sensor unit has afirst, second, and third pre-determined relationship to a first, second,and third reference location, respectively, on the bone 1104. In theexemplary embodiment illustrated in FIG. 11 , the first referencelocation is the ASIS point 1103 shown in contact with first contactmember 1117; the second reference location is the ASIS point 1103 incontact with second contact member 1106; and, the third reference point1115 is a point along the iliac crest 1105. Reference locations mayinclude, but are not limited to, ASIS points 1103, AIIS points (e.g.1217 of FIG. 12 ), palpable points along the iliac crest 1105, and pubictubercles 1113 (only one of which is shown).

To properly position the second sensor unit, the first, second, andthird contact members 1117, 1106, 1110, respectively, are brought intocontact with the first, second, and third reference locations, 1103,1103, 1115, respectively on the bone 1104 via first, second, and third,contact points 1107, 1109, 1111, respectively on the registration device1100.

With the second sensor unit 1130 properly positioned, information iscommunicated to the computing device (e.g. 511 of FIG. 5 ), as per block2807. Similarly to the method 2800 a of FIG. 28A, the informationrelates to the relative positioning of the second sensor with respect tothe reference sensor unit (e.g. 1211 of FIG. 12 ). Once again, theinformation may be communicated by either the second sensor unit 1130 orthe reference sensor unit (e.g. 1211 of FIG. 12 ).

By virtue of the known positional relationship between the second sensorunit 1130 and each of the three contact points 1107, 1109, 1111, therelative position of the bone 1104 with respect to the reference sensorunit (e.g. 1211 of FIG. 12 ) can be calculated from the informationcommunicated between the second sensor unit 1130 and/or the referencesensor unit (e.g. 1211 of FIG. 12 ) and the computing device (e.g. 511of FIG. 5 ).

At block 2818 b, the first, second, and third pre-determinedrelationships between the sensor location and the first, second, andthird reference locations, respectively, are input into the computingdevice (e.g. 511 of FIG. 5 ). At block 2820 b, like at block 2820 a, thecomputing device (e.g. 511 of FIG. 5 ) correlates the first second andthird information with the pre-determined geometry stored within thecomputing device. The correlation allows the position of the bone 1104to be determined with respect to the reference sensor unit (e.g. 1211 ofFIG. 12 ).

A method 2900 for determining the relative positioning of a bone withrespect to a rigid body is now discussed with reference to FIG. 29 .Reference will also be made to FIG. 13 , in which an exemplaryembodiment is illustrated wherein the bone is a pelvis 1304 of a patient1307, and the rigid body is the femur 1306 of the patient. At block2902, a first (or reference or pelvis) sensor unit 1311 is operativelyconnected to a bone (pelvis 1304), for example, as described above. Theoperative connection may be achieved via pin or bone screw 1310 a,according to technique known to those ordinarily skilled in the art.

At block 2904, a second sensor unit (femur sensor unit 1305) isoperatively connected to the rigid body (femur 1306). The operativeconnection may be achieved in the same manner described for theoperative connection of first (or reference or pelvis) sensor unit 1311to pelvis 1304.

At block 2906, a signal is emitted by one of (or both) the first andsecond sensor units, and at block 2908, the signal is detecting by theother of (or both) the first and second sensor units. The signal may,for example, be an IR signal emitted by IR emitters (see e.g. emitters705, 715, and 725 in FIGS. 7A, 7B, and 7C) within the sensor unit. Insuch an embodiment, the detecting sensor (whether it be the first orsecond sensor unit or both) is adapted to detect IR signals.

The combination of the first and second sensor units may be selectedaccording to the information that is desired. For example, where 6-DOFrelative positioning is required, a combination of at least one opticalsensor and at least three markers or emitters (preferably in a knownpositional relationship with one another) visible to the optical sensormay suffice, though additional optical sensors may be beneficial forfield of view and accuracy.

Measurements from inertial sensors (i.e. accelerometers and gyroscopes)may be used to infer positioning information. However, determiningpositioning (whether angular or translational) from inertialmeasurements typically relies on integrating a signal, which, in thepresence of noise, will result in drift in the inferred position. Thedrift increases as a function of time. It will be appreciated by thoseskilled in the art that the first and second sensor units mayincorporate inertial sensors to improve the accuracy of the positioningcalculated and displayed by the computing device. Furthermore,incorporating inertial sensors into the first and second sensor unitsmay allow the line of sight between the at least one optical sensor (onthe first and/or second sensor units) and the emitter(s) or marker(s) tobe temporarily broken, during which time the relative positioning of thefirst and second sensor units may be inferred from inertialmeasurements.

At block, 2910, information derived from the signal (or signals) andpossibly other sensed information (e.g. accelerometer measurements,gyroscope measurements, etc.) is communicated to a computing device(e.g. 511 of FIG. 5 ). The information derived from the signal (orsignals) relates to the positional relationship between the opticalsensors and the markers or emitters.

At block 2912, the information is processed to determine the relativepositioning between the bone 1304 and the rigid body 1306. Optionally,the processed information may be displayed in a display (e.g. 514 ofFIG. 5 ), for example, for a surgeon.

IV. Computer Implementation

In one embodiment, communication and/or data transmission between thevarious components of the present invention is accomplished over anetwork consisting of electronic devices connected either physically orwirelessly. Such devices (e.g., end-user devices and/or servers) mayinclude, but are not limited to: a desktop computer, a laptop computer,a handheld device or PDA, a cellular telephone, a set top box, anInternet appliance, an Internet TV system, a mobile device or tablet, orsystems equivalent thereto. Exemplary networks include a Local AreaNetwork, a Wide Area Network, an organizational intranet, the Internet,or networks equivalent thereto. The functionality and system componentsof an exemplary computer and network are further explained inconjunction with FIG. 30 .

In one embodiment, for example, the invention is directed toward one ormore computer systems capable of carrying out the functionalitydescribed herein. For example, FIG. 30 is a schematic drawing of acomputer system 3000 used to implement the methods presented above.Computer system 3000 includes one or more processors, such as processor3004. The processor 3004 is connected to a communication infrastructure3006 (e.g., a communications bus, cross-over bar, or network). Computersystem 3000 can include a display interface 3002 that forwards graphics,text, and other data from the communication infrastructure 3006 (or froma frame buffer not shown) for display on a local or remote display unit3030.

Computer system 3000 also includes a main memory 3008, such as randomaccess memory (RAM), and may also include a secondary memory 3010. Thesecondary memory 3010 may include, for example, a hard disk drive 3012and/or a removable storage drive 3014, representing a floppy disk drive,a magnetic tape drive, an optical disk drive, flash memory device, etc.The removable storage drive 3014 reads from and/or writes to a removablestorage unit 3018. Removable storage unit 3018 represents a floppy disk,magnetic tape, optical disk, flash memory device, etc., which is read byand written to by removable storage drive 3014. As will be appreciated,the removable storage unit 3018 includes a computer usable storagemedium having stored therein computer software, instructions, and/ordata.

In alternative embodiments, secondary memory 3010 may include othersimilar devices for allowing computer programs or other instructions tobe loaded into computer system 3000. Such devices may include, forexample, a removable storage unit 3022 and an interface 3020. Examplesof such may include a program cartridge and cartridge interface (such asthat found in video game devices), a removable memory chip (such as anerasable programmable read only memory (EPROM), or programmable readonly memory (PROM)) and associated socket, and other removable storageunits 3022 and interfaces 3020, which allow computer software,instructions, and/or data to be transferred from the removable storageunit 3022 to computer system 3000.

Computer system 3000 may also include a communications interface 3024.Communications interface 3024 allows computer software, instructions,and/or data to be transferred between computer system 3000 and externaldevices. Examples of communications interface 3024 may include a modem,a network interface (such as an Ethernet card), a communications port, aPersonal Computer Memory Card International Association (PCMCIA) slotand card, etc. Software and data transferred via communicationsinterface 3024 are in the form of signals 3028 which may be electronic,electromagnetic, optical or other signals capable of being received bycommunications interface 3024. These signals 3028 are provided tocommunications interface 3024 via a communications path (e.g., channel)3026. This channel 3026 carries signals 3028 and may be implementedusing wire or cable, fiber optics, a telephone line, a cellular link, aradio frequency (RF) link, a wireless communication link, and othercommunications channels.

In this document, the terms “computer-readable storage medium,”“computer program medium,” and “computer usable medium” are used togenerally refer to media such as removable storage drive 3014, removablestorage units 3018, 3022, data transmitted via communications interface3024, and/or a hard disk installed in hard disk drive 3012. Thesecomputer program products provide computer software, instructions,and/or data to computer system 3000. These computer program productsalso serve to transform a general purpose computer into a specialpurpose computer programmed to perform particular functions, pursuant toinstructions from the computer program products/software. Embodiments ofthe present invention are directed to such computer program products.

Computer programs (also referred to as computer control logic) arestored in main memory 3008 and/or secondary memory 3010. Computerprograms may also be received via communications interface 3024. Suchcomputer programs, when executed, enable the computer system 3000 toperform the features of the present invention, as discussed herein. Inparticular, the computer programs, when executed, enable the processor3004 to perform the features of the presented methods. Accordingly, suchcomputer programs represent controllers of the computer system 3000.Where appropriate, the processor 3004, associated components, andequivalent systems and sub-systems thus serve as “means for” performingselected operations and functions. Such “means for” performing selectedoperations and functions also serve to transform a general purposecomputer into a special purpose computer programmed to perform saidselected operations and functions.

In an embodiment where the invention is implemented using software, thesoftware may be stored in a computer program product and loaded intocomputer system 3000 using removable storage drive 3014, interface 3020,hard drive 3012, communications interface 3024, or equivalents thereof.The control logic (software), when executed by the processor 3004,causes the processor 3004 to perform the functions and methods describedherein.

In another embodiment, the methods are implemented primarily in hardwareusing, for example, hardware components such as application specificintegrated circuits (ASICs). Implementation of the hardware statemachine so as to perform the functions and methods described herein willbe apparent to persons skilled in the relevant art(s). In yet anotherembodiment, the methods are implemented using a combination of bothhardware and software.

Embodiments of the invention, including any systems and methodsdescribed herein, may also be implemented as instructions stored on amachine-readable medium, which may be read and executed by one or moreprocessors. A machine-readable medium may include any mechanism forstoring or transmitting information in a form readable by a machine(e.g., a computing device). For example, a machine-readable medium mayinclude read only memory (ROM); random access memory (RAM); magneticdisk storage media; optical storage media; flash memory devices;electrical, optical, acoustical or other forms of propagated signals(e.g., carrier waves, infrared signals, digital signals, etc.), andothers. Further, firmware, software, routines, instructions may bedescribed herein as performing certain actions. However, it should beappreciated that such descriptions are merely for convenience and thatsuch actions in fact result from computing devices, processors,controllers, or other devices executing firmware, software, routines,instructions, etc.

V. Additional Embodiments

In one embodiment, there is provided a system for performing a hipreplacement surgery, comprising: (1) a pelvis sensor unit configured tobe coupled to a patient's pelvis; (2) a registration sensor unit; (3) aninsertion tool sensor unit configured to be coupled to an acetabularinsertion tool; and (4) a femur sensor unit configured to be coupled tothe patient's femur. The system further comprises a computer-readablestorage medium having instructions executable by at least one processingdevice that, when executed, cause the processing device to: (a)calculate a positional relationship between the pelvis sensor unit andthe patient's pelvis based on a registration measurement between thepelvis sensor unit and the registration sensor unit, wherein theregistration measurement is based on at least three reference points;(b) measure an initial positional relationship between the pelvis sensorunit and the femur sensor unit (i.e., while the native hip joint isstill intact), (c) track an orientation of the acetabular insertion toolduring an implantation procedure based on a positional relationshipbetween the pelvis sensor unit and the insertion tool sensor unit, (d)calculate angles of abduction and anteversion based on the orientationof the acetabular insertion tool with respect to the pelvis, (e) providea real-time display conveying the angles of abduction and anteversionduring the implantation procedure, (f) measure a post-reductionpositional relationship between the pelvis sensor unit and the femursensor unit (i.e. during a trial or final reduction using prostheticcomponents), (g) calculate a change in leg position based on the initialpositional relationship (between the femur sensor and the pelvissensor), the post-reduction positional relationship (between the femursensor and the pelvis sensor), and the positional relationship betweenthe pelvis sensor unit and the patient's pelvis, and (h) provide adisplay of the change in leg position. The initial positionalrelationship may include an initial leg translational measurement. Theinitial positional relationship may include an initial leg orientationmeasurement. The change in leg position may be calculated based on acomparison between the initial positional relationship and thepost-reduction positional relationship. The change in leg position mayalso be calculated based on a femur articulation measurement between thepelvis sensor unit and the femur sensor unit. The change in leg positionmay also include a leg length measurement, an offset measurement, and/oran anterior-posterior position measurement.

The computer-readable storage medium may further include instructionsexecutable by at least one processing device that, when executed, causethe processing device to: (i) track a femur orientation during a legpositioning procedure based on a positional relationship between thepelvis sensor unit and the femur sensor unit; (j) provide a real-timedisplay conveying the femur orientation during the leg positioningprocedure; and/or (k) calculate a center-of-rotation of the patient'sfemur. The center-of-rotation may be calculated based on an acetabulumsurface measurement between the pelvis sensor unit and the registrationsensor unit. The center-of-rotation may be calculated based on a femurarticulation measurement between the pelvis sensor unit and the femursensor unit.

In another embodiment, there is provided a system for performing a hipreplacement surgery, including (1) a pelvis sensor unit configured to becoupled to a patient's pelvis; (2) a reference sensor unit; and (3) acomputer-readable storage medium having instructions executable by atleast one processing device that, when executed, cause the processingdevice to: (a) calculate a positional relationship between the pelvissensor unit and the patient's pelvis based on a registration measurementbetween the pelvis sensor unit and the reference sensor unit, whereinthe registration measurement includes at least three reference points;(b) track an orientation of an acetabular insertion tool during animplantation procedure based on a positional relationship between thepelvis sensor unit and the reference sensor unit, wherein the referencesensor unit is coupled to the acetabular insertion tool during theimplantation procedure, (c) calculate implant parameters based on theorientation of the acetabular insertion tool (implant parameters being,for example, cup position, change in cup position, cup orientation, orany other information based on the positional relationship), and (d)provide a real-time display of the implant parameters during theimplantation procedure.

The computer-readable storage medium may further include instructionsexecutable by at least one processing device that, when executed, causethe processing device to: (e) calculate an initial leg position based ona initial positional relationship measurement between the pelvis sensorunit and the reference sensor unit, wherein the reference sensor unit iscoupled to the patient's femur, (f) measure a post-reduction legposition based on a post-reduction positional relationship between thepelvis sensor unit and the reference sensor unit, (g) calculate a changein leg position between the initial leg position and the post-reductionleg position, (h) provide a display of the change in leg position; (i)calculate a center-of-rotation of the patient's femur; (j) track a femurorientation during a leg positioning procedure based on a positionalrelationship between the pelvis sensor unit and the reference sensorunit when the reference sensor unit is coupled to the patient's femur;and/or (k) provide a real-time display conveying the femur orientationduring the leg positioning procedure.

The initial leg position may be calculated based, in part, on an initialleg length measurement. The initial leg position may be calculatedbased, in part, on an initial leg orientation measurement. The initialleg position may be calculated based, in part, on a positionalrelationship between the pelvis sensor unit and the reference sensorunit when the reference sensor unit is coupled to the patient's femur.In an alternative embodiment, the change in leg position may becalculated based on a femur articulation measurement between the pelvissensor unit and the reference sensor unit, wherein the reference sensorunit is coupled to the patient's femur during the femur articulationmeasurement. The change in leg position may include a leg lengthmeasurement, an offset measurement, and/or an anterior-posteriorposition measurement.

The center-of-rotation may be calculated based on an acetabulum surfacemeasurement between the pelvis sensor unit and the reference sensorunit, wherein the reference sensor unit is brought in contact with threeor more points along the acetabulum surface. The center-of-rotation mayalso be calculated based on a femur articulation measurement between thepelvis sensor unit and the reference sensor unit, wherein the referencesensor unit is coupled to the patient's femur during the femurarticulation measurement.

In still another embodiment, there is provided a system for performing ahip replacement surgery, including (1) a pelvis sensor unit configuredto be coupled to a patient's pelvis; (2) a reference sensor unit; and(3) a computer-readable storage medium having instructions executable byat least one processing device that, when executed, cause the processingdevice to: (a) calculate a positional relationship between the pelvissensor unit and the patient's pelvis based on a registration measurementbetween the pelvis sensor unit and a reference sensor unit, wherein theregistration measurement includes at least three reference points; (b)calculate an initial leg position based on a initial positionalrelationship measurement between the pelvis sensor unit and thereference sensor unit when the reference sensor unit is coupled to thepatient's femur, (c) track a femur orientation during a leg positioningprocedure based on a positional relationship between the pelvis sensorunit and the reference sensor unit, (d) provide a real-time displayconveying the femur orientation during the leg positioning procedure,(e) measure a post-reduction leg position based on a positionalrelationship between the pelvis sensor unit and the reference sensorunit, (f) calculate a change in leg position between the initial legposition and the post-reduction leg position, and (g) provide a displayof the change in leg position.

The computer-readable storage medium may further include instructionsexecutable by at least one processing device that, when executed, causethe processing device to calculate a center-of-rotation of the patient'sfemur. The center-of-rotation may be calculated based on an acetabulumsurface measurement between the pelvis sensor unit and the referencesensor unit, wherein the reference sensor unit is brought in contactwith three or more points along the acetabulum surface. Thecenter-of-rotation may calculated based on a femur articulationmeasurement between the pelvis sensor unit and the reference sensorunit, wherein the reference sensor unit is coupled to the patient'sfemur during the femur articulation measurement.

The change in leg position may be calculated based on a femurarticulation measurement between the pelvis sensor unit and thereference sensor unit, wherein the reference sensor unit is coupled tothe patient's femur during the femur articulation measurement. Thechange in leg position includes a leg length measurement, an offsetmeasurement, and/or an anterior-posterior position measurement.

In still another embodiment, there is provided a computer-readablestorage medium, for performing hip replacement surgery, havinginstructions executable by at least one processing device that, whenexecuted, cause the processing device to: (a) calculate a positionalrelationship between a pelvis sensor unit and a patient's pelvis, whenthe pelvis sensor unit is coupled to a first point on a patient'spelvis; (b) calculate an initial leg position based on a positionalrelationship between the pelvis sensor unit and a sensor unit coupled tothe patient's femur; (c) track an orientation of an acetabular insertiontool during an implantation procedure based on a positional relationshipbetween the pelvis sensor unit and a sensor unit coupled to theacetabular insertion tool; (d) calculate implant parameters based on theorientation of the acetabular insertion tool; (e) provide a real-timedisplay conveying the implant parameters during the implantationprocedure; (f) track an orientation of the patient's femur during a legpositioning procedure based on a positional relationship between thepelvis sensor unit and the sensor unit coupled to the patient's femur;(g) provide a real-time display conveying the orientation of thepatient's femur during the leg positioning procedure; (h) measure apost-reduction leg position based on the positional relationship betweenthe pelvis sensor unit and the sensor unit coupled to the patient'sfemur; (i) calculate a change in leg position between the initial legposition and the post-reduction leg position; and (j) provide a displayof the change in leg position. The implant parameters include angles ofabduction and anteversion. In alternative embodiments, thecomputer-readable storage medium performs only one or more of the abovelisted functions, or performs the above listed functions in varyingorders, or in parallel or serial steps.

In another embodiment, there is provide a computer-readable storagemedium, for performing hip replacement surgery, having instructionsexecutable by at least one processing device that, when executed, causethe processing device to (a) calculate a positional relationship betweena pelvis sensor unit and a patient's pelvis, when the pelvis sensor unitis coupled to a first point on a patient's pelvis; (b) calculate aninitial leg position based on a positional relationship between thepelvis sensor unit and a sensor unit coupled to the patient's femur; (c)track an orientation of an acetabular insertion tool during animplantation procedure based on a positional relationship between thepelvis sensor unit and a sensor unit coupled to the acetabular insertiontool; (d) calculate implant parameters based on the orientation of theacetabular insertion tool; (e) provide a real-time display conveying theimplant parameters during the implantation procedure; (f) track thepatient's femur during a leg positioning procedure based on a positionalrelationship between the pelvis sensor unit and the sensor unit coupledto the patient's femur; (g) measure a post-reduction leg position basedon the positional relationship between the pelvis sensor unit and thesensor unit coupled to the patient's femur; (h) calculate a change inleg position between the initial leg position and the post-reduction legposition; and (i) provide a display of the change in leg position. Theimplant parameters may include angles of abduction and anteversion. Thecomputer-readable storage may further comprise instructions executableby at least one processing device that, when executed, cause theprocessing device to (j) track an orientation of the patient's femurduring the leg positioning procedure based on a positional relationshipbetween the pelvis sensor unit and the sensor unit coupled to thepatient's femur; and (k) provide a real-time display conveying theorientation of the patient's femur during the leg positioning procedure.

CONCLUSION

The foregoing description of the invention has been presented forpurposes of illustration and description. It is not intended to beexhaustive or to limit the invention to the precise form disclosed.Other modifications and variations may be possible in light of the aboveteachings. The embodiments were chosen and described in order to bestexplain the principles of the invention and its practical application,and to thereby enable others skilled in the art to best utilize theinvention in various embodiments and various modifications as are suitedto the particular use contemplated. It is intended that the appendedclaims be construed to include other alternative embodiments of theinvention; including equivalent structures, components, methods, andmeans.

Accordingly, it is to be understood that this invention is not limitedto particular embodiments described, and as such may vary. It is also tobe understood that the terminology used herein is for the purpose ofdescribing particular embodiments only, and is not intended to belimiting.

As will be apparent to those of skill in the art upon reading thisdisclosure, each of the individual embodiments described and illustratedherein has discrete components and features which may be readilyseparated from or combined with the features of any of the other severalembodiments without departing from the scope or spirit of the presentinvention. Any recited method can be carried out in the order of eventsrecited or in any other order which is logically possible.

It is to be appreciated that the Detailed Description section, and notthe Summary and Abstract sections, is intended to be used to interpretthe claims. The Summary and Abstract sections may set forth one or more,but not all exemplary embodiments of the present invention ascontemplated by the inventor(s), and thus, are not intended to limit thepresent invention and the appended claims in any way.

What is claimed is:
 1. A system comprising: an optical sensor unitcomprising an optical sensor, and at least one human interface sensorconfigured to receive user input, wherein: the optical sensor isconfigured to detect light within a field of view, the field of view foraligning with a site of a procedure; and the optical sensor unit isconfigured to generate and communicate sensor information derived fromthe light received by the optical sensor; a bone sensor unit configuredto attach to a bone for determining a first position, the first positionassociated with the bone, the bone sensor unit comprising at least onefirst light reflector configured to provide to the optical sensor unit areflected light used to determine the first position in six degrees offreedom; a stylus sensor unit configured to attach to a stylus fordetermining a second position, the second position associated with thestylus, the stylus sensor unit comprising at least one second lightreflector configured to provide to the optical sensor unit a reflectedlight used to determine the second position in six degrees of freedom; atool sensor unit configured to attach to a surgical tool for determininga third position, the third position associated with the surgical tool,the tool sensor unit comprising at least one third light reflectorconfigured to provide to the optical sensor unit a reflected light usedto determine the third position in six degrees of freedom; anon-transitory computer readable storage device storing instructions,which when executed by a processor, cause the processor to perform stepscomprising: receiving from the optical sensor unit an input for invokinga registration of the bone sensor unit to the bone; performing theregistration to register a relative position of the bone sensor unit tothe bone in response to receiving the input and first sensor informationindicating references for the bone, the first sensor information derivedfrom the reflected light of the bone sensor unit and the stylus sensorunit; determining a relative position of the bone and the surgical toolin six degrees of freedom in accordance with the registration and secondsensor information, the second sensor information derived from thereflected light of the bone sensor unit and the tool sensor unit;determining display information in accordance with the relative positionof the bone and the surgical tool; and providing the display informationfor presenting by a display unit.
 2. The system of claim 1, wherein thebone is one of a pelvis and a femur.
 3. The system of claim 1, whereinthe surgical tool comprises one of a tool for joint replacement surgery,a tool for joint resurfacing surgery or a tool for joint revisionsurgery.
 4. The system of claim 1, wherein the bone comprises a pelvisand wherein the references for the bone comprise references for thepelvis for performing the registration.
 5. The system of claim 4,wherein the surgical tool comprises an acetabular insertion tool, andthe relative position of the bone and the surgical tool comprises arelative position of the pelvis and the acetabular insertion tool. 6.The system of claim 1, wherein: the instructions configure the processorto access a pre-determined geometry for the bone, the pre-determinedgeometry derived from an X-ray, a computed tomography (CT) scan or amagnetic resonance imaging (MRI) scan of the bone; and the step ofperforming the registration registers the bone sensor unit and thepre-determined geometry in a known relationship using the references forthe bone.
 7. The system of claim 1, wherein any one or more of the atleast one first light reflector, the at least one second light reflectoror the at least one third light reflector comprises at least onereflective marker.
 8. The system of claim 1, wherein the optical sensorcomprises a stereoscopic camera.
 9. The system of claim 1, wherein theoptical sensor unit comprises a handheld sensor unit.
 10. The system ofclaim 1 comprising one or both of the processor and the display unit.11. The system of claim 1, wherein the optical sensor unit comprises thedisplay unit.
 12. The system of claim 11, wherein the optical sensorunit comprises a housing for the optical sensor and a handle shaftextending from the housing.
 13. The system of claim 1, wherein thestylus sensor unit and the tool sensor unit comprise a same sensor unit.14. A method comprising: using a human interface sensor of an opticalsensor unit comprising an optical sensor to invoke a processor toperform a registration of a bone sensor unit to a bone from bonereferences indicated by a stylus coupled to a stylus sensor unit,wherein: the bone sensor unit is coupled to the bone for determining afirst position, the first position associated with the bone, and thebone sensor unit comprises at least one first light reflector configuredto provide to the optical sensor unit a reflected light used todetermine the first position in six degrees of freedom; the opticalsensor is configured to detect light within a field of view, the fieldof view for aligning with a site of a procedure; the optical sensor unitis configured to generate and communicate sensor information derivedfrom the light received by the optical sensor; and the stylus sensorunit is coupled to the stylus for determining a second position, thesecond position associated with the stylus and the stylus sensor unitcomprises at least one second light reflector to provide to the opticalsensor unit a reflected light used to determine the second position insix degrees of freedom; using the optical sensor unit to generate andcommunicate to the processor first sensor information derived from thereflected light from each of the bone sensor unit and the stylus sensorunit, the stylus sensor unit indicating the bone references and thefirst sensor information for determining a relative position of the boneand the stylus to perform the registration; using the optical sensorunit to generate and communicate to the processor second sensorinformation derived from reflected light from each of the bone sensorunit and a tool sensor unit to receive display information associatedwith a relative position of the bone and a surgical tool, wherein: thetool sensor unit is coupled to the surgical tool for determining a thirdposition, the third position associated with the surgical tool, and thetool sensor unit comprises at least one third light reflector configuredto provide to the optical sensor unit a reflected light used todetermine the third position in six degrees of freedom; and theprocessor is configured to: determine the relative position of the boneand the surgical tool using the registration and the second sensorinformation, determine the display information, and provide the displayinformation to a display unit; and receiving the display information viathe display unit.
 15. The method of claim 14, wherein the optical sensorunit comprises the display unit for receiving the display information.16. The method of claim 14, comprising holding the optical sensor unitby hand to use the optical sensor to generate and communicate either orboth of the first sensor information and the second sensor information.17. The method of claim 14 comprising any one or more of: coupling thebone sensor unit to the bone; coupling the stylus sensor unit to thestylus; and coupling the tool sensor unit to the surgical tool.
 18. Themethod of claim 14, wherein the bone is one of a pelvis and a femur. 19.The method of claim 14, wherein the surgical tool is one of a tool forjoint replacement surgery, a tool for joint resurfacing surgery and atool for joint revision surgery.
 20. The method of claim 14, wherein thebone comprises a pelvis and wherein the first sensor information isreceived for determining the bone references for the pelvis to performthe registration.
 21. The method of claim 20, wherein the surgical toolcomprises an acetabular insertion tool, and the display information isassociated with a relative position of the pelvis and the acetabularinsertion tool.
 22. The method of claim 14 comprising providing theprocessor with a pre-determined geometry for the bone, thepre-determined geometry derived from an X-ray, a computed tomography(CT) scan or a magnetic resonance imaging (MRI) scan of the bone; andwherein the registration registers the bone sensor unit and thepre-determined geometry in a known relationship using the bonereferences.
 23. The method of claim 14, wherein the optical sensorcomprises a stereoscopic camera.
 24. The method of claim 14, wherein thestylus sensor unit and the tool sensor unit comprise a same sensor unit.25. A non-transitory computer readable storage device storinginstructions, which when executed by a processor, cause the processor toperform steps comprising: receiving input from at least one humaninterface sensor of an optical sensor unit for invoking the processor toperform a registration of a bone sensor unit to a bone, wherein: theoptical sensor unit comprises an optical sensor configured to detectlight within a field of view, the field of view for aligning with a siteof a procedure; and the optical sensor unit is configured to generateand communicate sensor information derived from the light received bythe optical sensor; performing a registration to register a relativeposition of the bone sensor unit to the bone using first sensorinformation received from the optical sensor unit to perform theregistration, the first sensor information indicating references for thebone, the first sensor information derived from reflected light fromeach of the bone sensor unit and a stylus sensor unit, and wherein: thebone sensor unit is coupled to the bone for determining a firstposition, the first position associated with the bone, and the bonesensor unit comprises at least one first light reflector configured toprovide to the optical sensor unit a reflected light used to determinethe first position in six degrees of freedom; and the stylus sensor unitis coupled to a stylus for identifying the references for the bone, thestylus sensor unit is coupled to the stylus for determining a secondposition, the second position associated with the stylus and the stylussensor unit comprising at least one second light reflector to provide tothe optical sensor unit a reflected light used to determine secondposition in six degrees of freedom; determining a relative position ofthe bone and a surgical tool in six degrees of freedom in accordancewith the registration and second sensor information, the second sensorinformation derived from reflected light of the bone sensor unit and atool sensor unit, wherein the tool sensor unit is coupled to thesurgical tool for determining a third position, the third positionassociated with the surgical tool, and the tool sensor unit comprises atleast one third light reflector to provide to the optical sensor unit areflected light used to determine the third position in six degrees offreedom; determining display information in accordance with the relativeposition of the bone and the surgical tool; and providing the displayinformation for presenting by a display unit.
 26. The non-transitorycomputer readable storage device of claim 25, wherein the steps compriseaccessing a pre-determined geometry for the bone, the pre-determinedgeometry derived from an X-ray, a computed tomography (CT) scan or amagnetic resonance imaging (MRI) scan of the bone; and whereinperforming the registration registers the bone sensor unit and thepre-determined geometry in a known relationship using the references forthe bone.
 27. The non-transitory computer readable storage device ofclaim 25, wherein any one or more of: the optical sensor comprises astereoscopic camera; the optical sensor unit comprises a handheld sensorunit; the optical sensor unit comprises the display unit; the opticalsensor unit comprises a housing for the optical sensor and a handleshaft extending from the housing; the stylus sensor unit and the toolsensor unit comprise a same sensor unit; the bone comprises one of apelvis and a femur; and the surgical tool is one of a tool for jointreplacement surgery, a tool for joint resurfacing surgery and a tool forjoint revision surgery.
 28. A computer-implemented method comprisingexecuting by a processor steps comprising: receiving input from at leastone human interface sensor of an optical sensor unit for invoking theprocessor to perform a registration of a bone sensor unit to a bone,wherein: the optical sensor unit comprises an optical sensor configuredto detect light within a field of view, the field of view for aligningwith a site of a procedure; and the optical sensor unit is configured togenerate and communicate sensor information derived from the lightreceived by the optical sensor; performing a registration to register arelative position of the bone sensor unit to the bone using first sensorinformation received from the optical sensor unit, the first sensorinformation indicating references for the bone, the first sensorinformation derived from reflected light from each of the bone sensorunit and a stylus sensor unit, and wherein: the bone sensor unit iscoupled to the bone for determining a first position, the first positionassociated with the bone, and the bone sensor unit comprises at leastone first light reflector configured to provide to the optical sensorunit a reflected light used to determine the first position in sixdegrees of freedom; and the stylus sensor unit is coupled to a stylusfor identifying the references for the bone, the stylus sensor unit iscoupled to the stylus for determining a second position, the secondposition associated with the stylus and the stylus sensor unitcomprising at least one second light reflector to provide to the opticalsensor unit a reflected light used to determine the second position insix degrees of freedom; determining a relative position of the bone anda surgical tool in six degrees of freedom in accordance with secondsensor information, the second sensor information derived from reflectedlight of the bone sensor unit and a tool sensor unit, wherein the toolsensor unit is coupled to the surgical tool for determining a thirdposition, the third position associated with the surgical tool, and thetool sensor unit comprises at least one light third reflector to provideto the optical sensor unit a reflected light used to determine the thirdposition in six degrees of freedom; determining display information inaccordance with the relative position of the bone and the surgical tool;and providing the display information for presenting by a display unit.29. The computer implemented method of claim 28, wherein the stepscomprise accessing a pre-determined geometry for the bone, thepre-determined geometry derived from an X-ray, a computed tomography(CT) scan or a magnetic resonance imaging (MRI) scan of the bone; andwherein performing the registration registers the bone sensor unit andthe pre-determined geometry in a known relationship using the referencesfor the bone.
 30. The computer implemented method of claim 28, whereinany one or more of: the optical sensor comprises a stereoscopic camera;the optical sensor unit comprises a handheld sensor unit; the opticalsensor unit comprises the display unit; the optical sensor unitcomprises a housing for the optical sensor and a handle shaft extendingfrom the housing; the stylus sensor unit and the tool sensor unitcomprise a same sensor unit; the bone comprises one of a pelvis and afemur; and the surgical tool is one of a tool for joint replacementsurgery, a tool for joint resurfacing surgery and a tool for jointrevision surgery.